The Features of Mobile-Based Software in Self-Management of Patients with Asthma: A Review Article

Background: The use of mobile-based software for the self-management of patients with asthma improves the quality of life, reduces healthcare costs, provides effective health care interventions in asthma, and supports the patients in self-management. The current study was performed to identify the features of mobile-based self-management software for patients with asthma (MSSPA). Materials and Methods: The present review study was performed in 2018. Four databases including PubMed, Scopus, Emerald, and Google Scholar were screened by the combination of selected keywords. Data were collected using a data extraction form. Data were analyzed using the content analysis method. Results were abstracted and reported based on the study objectives. Results: Of the 297 articles retrieved during the first round of search, 24 were selected; 15 of which were the original articles (62.5%). As the most important applications of MSSPA, it could be used as a tool to support patients in self-management, provide them with educational information, and self-observation. Also, 75% of the studies (n=18) emphasized the effectiveness of MSSPA. Identification of the required field of the software was the most important requirement in using MSSPA. Nevertheless, some of the studies reported the low quality and compatibility of some designed apps compared with those of the available information systems. Conclusion: Identification of MSSPA features and considering them in new versions can promote the quality of MSSPA. However, according to the results of the study, in addition to identifying the software features, more attention should be paid to the users’ needs in software design.


Study Selection:
The current review study was performed in 2018 to identify the features of MSSPA. The searches were conducted through PubMed, Scopus, Emerald, and Google Scholar databases using the combination of keywords shown in Table 1. All the review and original articles available with full texts and relevant topics were searched and reviewed in the current study. Also, all articles published in non-English languages, with unavailable full texts, irrelevant topics, and low quality were excluded from the study. All the study steps were conducted in accordance with PRISMA statement. The searches were performed by two researchers independently in order to prevent possible bias. In case of bias, contradictions were resolved by consulting with a third party. ("Mobile health" OR "M Health" OR "mobile" OR "tablet" OR "portable devices" OR "Application" OR "mobile software*" OR "App*") #2 ("Asthma") #3 ("Self-management") were reported based on the study objectives.

RESULTS
Of the 297 articles retrieved during the first stage of the search, considering the inclusion and exclusion criteria, finally 24 articles were selected in the current study ( Figure   1). The characteristics of all the 24 articles selected in the study are shown in Table 2.

Supporting decision making
Decision support (34), Assessment of lungs efficiency (38), one article was about pregnant women with asthma.
Findings of the study showed that seven studies (29.17%) were qualitative researches. Figure 2 shows the frequency of articles based on the type. The results of the study also showed that in addition to patients and physicians, healthcare providers and patients' families and friends were other individuals affected by such the software.
Regarding the study objectives, the features of MSSPA were categorized into four dimensions including applications, requirements, effects, and limitations.

A) Applications
The applications are shown in Table 3.
According to Table 3, the main application of MSSPA was in disease control.

B) Requirements
The requirements are mentioned in the second part of the study results. Identifying the MSSPA requirements is important. According to the goals of the Health Insurance Portability and Accountability Act (HIPAA) (31), conducting further studies to obtain more definitive results (39,40), paying more attention to patients with mental conditions (41), identifying the fields required to the software (33), as well as its interactivity and dynamicity (37), and training the elderly and other individuals in using mobile should be considered (34,37).

Primary search in databases
Review the title of papers (Duplication) N=182

Review the abstracts N=199
Relevancy N=47

Controlling of asthma
Based on the results of the study, MSSPA could be applied to control the disease, particularly in uncontrolled cases. Cook et al. in a study concluded that mobile-based applications can be used as an effective tool to control uncontrolled asthma (27). Another study showed that physicians are more inclined to use m-health tools as an alert system for patients under critical conditions (32).
It seems that the prescription of mobile-based software, with the required standards and permissions, to patients with uncontrolled asthma can be a good measure for selfmanagement of the disease.

Providing useful information
The results of the study showed that 16.66% of the selected articles recommended the use of MSSPA by patients in order to obtain useful information. Therefore, the instructions and guides for asthma self-management provided in the software can be used by patients, and then they independently can take place in the self-management program. Hai in a study noted the employment of mobilebased applications in patient education as one of the seven main features of MSSPA (34). Therefore, it is suggested to embed educational information about asthma in mobilebased software used by patients for self-management purposes.

Monitoring of patients
Patients with asthma have chronic and sensitive conditions, which require more caring and monitoring, which highlights the use of MSSPA for this purpose.

Scheduling appointments and e-booking
In some studies, the feasibility of scheduling doctor's appointments and e-booking is considered as the main application of MSSPA, which is a benefit to both patients and physicians (38). Embedding such an option in mobilebased applications helps the patients schedule their appointments with no anxiety.

Self-assessment and self-observation of patients
According to the study findings, some researchers emphasized self-assessment and self-observation of patients (35,43). Self-assessment and self-observation involve patients in treatment trends and sensitize them to their situation via assessing health conditions; as a result, the MSSPA can improve self-management in patients.
Using such apps, physicians can better monitor the patient's health status, prescribe drugs, and give advice (32).

Supporting decision making
Supporting decision making is one of the applications of this software for physicians (34). This capability can encourage physicians to employ MSSPA. Despite its difficulties, producing software with such options seems essential.

Requirements
There are many requirements for MSSPA, and more attention should be paid to them in software development.
The results of the study showed the high importance of the security and privacy of such applications. Tinschert  Other results showed that such apps should possess the feasibility of sharing the data of adolescents with asthma with their parents as it can support them both financially and technically, and in turn improve patient's selfmanagement (35). Therefore, this option seems essential for this group of patients.

Effects
The current study results showed that 75% of the selected articles emphasized effectiveness of mobile-based software in the improvement of self-management of patients with asthma from the viewpoint of both physicians and patients. methods; further studies in this field is recommended (24).

Limitations
The results of the study showed that in some articles the software has a low quality and compatibility compared with the available information systems (31,40). Neglecting